Peer Review Manual and Brochure

The American Dental Association's manual, Peer Review in Focus, and the peer review flyer, brochure and mediation checklist are now available for download. The manual and brochures are reviewed every year to update the information. Constituent and component dental societies may use or adapt portions of the manual or the entire manual. The American Dental Association supports the profession's peer review programs, by providing recommendations on how the peer review programs should be organized and conducted, and the considerations that are inherent in the evolution of peer review policy. Those recommendations are presented in the American Dental Association's manual, Peer Review in Focus. The American Dental Association's brochures, serves as a convenient overview that can be given to parties who are about to participate in peer review. The mediation checklist will give an overview of the process one would follow in the mediation process.

Peer Review Actions and the National Practitioners Data Bank

The National Practitioner Data Bank (NPDB) was established in 1986 under the Health Care Quality and Improvement Act of 1986. The NPDB is an information clearinghouse that collects information related to the professional competence and conduct of physicians, dentists and, in some cases, other health care professionals; the information is released upon request to eligible entities.

Depending on the facts and circumstances of a case, a fee refund resulting from peer review could be a medical malpractice payment, reportable to the NPDB by the dental society or the dentist, whoever makes the payment.

A "medical malpractice payment," as interpreted by the U.S. Department of Health and Human Services (HHS) is: (1) any payment of money; (2) by an entity; (3) for or for the benefit of a health care practitioner; (4) resulting from a written claim or demand for payment; and (5) based on the provision of, or failure to provide, services. Each of these elements must be present in order for a reporting obligation to exist. A good source of information on reporting and querying the NPDB can be found at www.npdb-hipdb.com.

Access to the NPDB is limited. For example, patients, at this time, may not query the data bank. Attorneys may query the NPDB only if they represent a plaintiff in a malpractice action against a hospital and an issue is whether the hospital queried the data bank, as it is required to do by law, before granting staff privileges to a specific practitioner. The practitioner must also be a defendant in the case. A dentist may query the data bank about him or herself, but not about others. For information on how to query the data bank, call 800.767.6732.

Peer Review Programs

State dental associations conduct peer review programs to settle disputes between patients and dentists or third-party payers and dentists. Disputes that may be addressed through peer review involve appropriateness of care, quality of care or whether a fee in question is the dentist's usual fee for a procedure, based on the difficulty or complexity of the dental procedure.

The procedure for initiating peer review is to contact the component (local) dental society and request peer review. The component society conducts the peer review and coveys its decision to the dentist and other party involved in the peer review. Under some circumstances, decisions of the peer review committee at the component level can be appealed to the state dental association by either the dentist or the other involved party.

How the Dental Peer Review Program Works and What you can Expect From it

This paper explains in detail how a dentist can navigate the peer review system and what can be expected from it.